Today I got my bi-monthly journal of the American Association of Suicidology, Suicide and Life Threatening Behavior. My cousin came over and my mother said to him that I like reading that kind of material. I do but on another level, I feel embarrassed. I know I am taking it personally because it is personal. I attempted suicide many times over the years and each time I fail it is not only a failure, but it also is an embarrassment to my ego. I have the scars to show of the self injurious behavior I have had over the years. Again, an embarrassment of my illness. I don’t know why I feel this way. Or maybe shame is another reason I feel embarrassed. I don’t know. But it hurts. It hurts knowing that I failed and I am still here. I don’t know why it does but it hurts like hell. I have not told anyone about the shame that I feel other than my blog and maybe my therapist. There is so much I tell her that I sometimes forget if I tell her about the shame of living. I know people who have attempted don’t like to talk openly to the person in front of them about their story of attempt. I don’t think I can speak openly in front of a crowd of people and tell them I have attempted and failed and now I feel like a complete and utter failure. That I want to try again and succeed just to try to cheat death. But I have people that rely on me to be here and though I sometimes resent them for it and even hate them for it, I still continue living. I don’t enjoy living. It’s a constant struggle for me for one thing to another. It’s more of a hassle living than anything. Between the chronic pain that I feel physically to the chronic pain I feel emotionally, why bother? But I do because I don’t think I can ever again act on my feelings. I lost what is called lethality. And until I get it back, I am still going to be living this so called hell called life.
Category: psychache
stigma and suicide
Stigma and suicidality
“Among the 10 leading causes of death in the U.S. most are claiming fewer lives each year but sadly suicide is on of the few that continues to rise. Depression and other diseases of the mind that contribute to suicide are real illnesses, not weaknesses. Not character flaws. People battling these illnesses deserve understanding and treatment afforded people with any other llness.” Robert Gabbia AFSP Executive Director.
There is a stigma out there that mental illnesses are not real. That if you just pull your boot straps up you will be ok and not suffer from depression. I have a friend in Canada, a place where the suicide rate is higher than the US because they are still in the dark about treating depression and other mental illnesses. Like Mr. Gabbhia states this is not a character flaw or a weakness. This is real. It takes character and strength to admit there is something wrong and to see help for it. And if you don’t succeed the first time try again until you do.
If I didn’t try and try again, I probably wouldn’t be here today. I probably would have taken my life. I have seen over 10 therapists over the course of my treatment for my mental illness. My current therapist I have been with for the past twelve years and it has been the a huge difference. With the stability of treatment providers I don’t go to the hospital as much and with the value of trust between us, I can state my suicidal feelings without being held against my will in some treatment facility. I am open about how I feel with my therapist but it took a long time to get to where I was. It took about 3-4 years to really trust her and for her to trust me.
I say that it takes trust between us because most therapist are under the believe that all people that have suicidal thoughts should be hospitalized immediately if they cannot be held to safety contracts, which are worthless. Therapist think this is the way to go but it is not. It just takes the legality of it all away from the therapist and really does not put trust in the relationship. Nor does it build an alliance with the therapist because the client is always in fear of being put into the hospital for fear of stating their true feelings. Is that how therapy is supposed to go? Again you have the stigma that if you talk about suicide, you will cause suicide. That is a common myth that everyone still believes is true except for those that actually deal with it. Like me and other suicidologists around the country. Those that deal with suicide are afraid of being sued but there are measures that can be taken so that it is not as frightening as it is. I am not saying that the person with a loaded gun or is in eminent danger and threatening suicide should not be hospitalized and that that gun or other means NOT be taken away. I am saying for those that are chronically suicidal be given a chance that doesn’t include the hospital all the time. In the course of my therapy over the past twelve years I have been hospitalized 4-6 times, compared to twice a year for the previous ten years.
For resources on dealing with suicide:
http://www.suicidology.org the American Association of Suicidology.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Nemo, The Blizzard of 2013, New England
Nemo, The Blizzard of 2013, New England
I have lived in Boston most of my life and the craziness every time the word “snow” is mentioned is wicked funny. People go crazy in the stores thinking the world is going to end. They buy ridiculous amounts of milk, eggs, bread and other items that will probably go bad if the power goes out during the supposed storm. I have been taking pictures since noon time to compare the accumulation for my friends in the UK and elsewhere. It is kind of fun doing so.
Right now I am installing software on my old laptop because the software is not compatible on my new laptop. I have to get a newer version for it but I am not going to pay another $80 USD for this software when my old laptop can still run it. Even if I did it would take me years to figure it out like when I first bought this software. I just wanted to burn CD’s. And it was complicated. I needed the 200 page manual to figure it out. I am not a software geek that is for sure.
On a personal note, I am a man again! My 7 and a half week siege of the menses has ceased. I can now go back to my manly clothing. I am so happy I think it knocked out the cutting urges finally. I still feel depressed but it’s just my normal level of depression. Though the psychache is still there. That has not lifted at all. I don’t think that ever will. It’s always there like a monkey on my back. I am going to try and work in a shower today. I really need it and then I can slip into my boxers again. I am so relieved that stopping the OCP’s worked. I was really getting worried that something was wrong.
comparisons of psychological pain scales
Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.
Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.
Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.
Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.
These combined formed my contention that psychological pain is a causal factor in suicidal thinking.
Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.
Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.
OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.
Holden scale.
Dr. Holden’s psychache scale is a thirteen question self-report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.
These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.
Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Copyright 2013 Collerone, G
midnightdemons7 
You must be logged in to post a comment.